The overall aims of this five-year Career Development Award are to: 1) enable the candidate's career development as an independent clinical researcher through advanced didactic coursework, structured mentoring, and conduct/analysis of a clinical research study;and 2) better understand the epidemiology and pathophysiology of ambulatory blood pressure (BP), specifically elevated nighttime BP, in subjects with chronic kidney disease (CKD). Hypertension is highly prevalent and is a major risk factor for cardiovascular disease, kidney disease, and death. BP is traditionally measured in the clinic, but there is increasing interest in ambulatory BP monitoring. The best ambulatory BP predictor appears to be nighttime BP. CKD has been shown to be a risk factor for elevated nighttime BP. Cardiac autonomic neuropathy is associated with elevated nighttime BP in patients with and without CKD. The relationship between CKD, cardiac autonomic neuropathy, and elevated nighttime BP is not well studied. The candidate will conduct a cross-sectional and longitudinal study of ambulatory BP in subjects enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, and collect additional data as part of the approved Epidemiology and Pathophysiology of Elevated Nighttime Blood Pressure in CKD Ancillary Study. The specific aims of the candidate's proposed study are: 1) determine the prevalence of masked hypertension, white-coat hypertension, and true hypertension in patients with CKD;2) evaluate the clinical characteristics, including cardiac autonomic neuropathy, associated with elevated nighttime BP in patients with CKD;and 3) evaluate the clinical characteristics associated with a change in nighttime BP over time in patients with CKD. Data will include detailed medical history, laboratory evaluation, electrocardiograms, comprehensive cardiovascular evaluation, and ascertainment of clinical outcomes. Statistical analysis will include multiple linear and logistic regressions. The candidate will be mentored by a multidisciplinary team led by Dr Mahboob Rahman, a principal investigator in CRIC and an experienced researcher with expertise in hypertension and CKD. The candidate has shown a dedication to a career in research through work as a Clinical Research Scholar and will enhance this research experience and formal training by taking advanced coursework in statistics and epidemiology. In addition to the advanced didactic coursework and mentored research experience, the candidate will participate in research and career development seminars and conferences as a faculty member in the Department of Medicine and the Center for Clinical Investigation. This Career Development Award will provide the foundation for the candidate to pursue an independent research career dedicated to better understanding the pathophysiology of and reducing the subsequent morbidity and mortality associated with chronic kidney disease and hypertension. PUBLIC HEALTH RELEVANCE: High blood pressure is common and is a major risk factor for cardiovascular disease, kidney disease, and death. Nighttime blood pressure may be the best predictor for adverse clinical events but is not well sudied. A better understanding of the mechanisms that lead to elevated nighttime BP will provide insight for future clinical trials that specifically target elevated nighttime BP with the goal of reducing morbidity and mortality.